Plavix after CABG

[bedrock]

What is the standard of care for non-interrupted Plavix after CABG?

After cardiac stents, I know it's one year and I don't take patients off Plavix during the first year due to risk of graft occlusion, and just manage them medically.

Is is the same strict 12 month rule after CABG? I would think that the patient's own vessels used for CABG would be less likely to occlude after 7 days off Plavix, than an artificial stent.

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[PinchandBurn]

What is the standard of care for non-interrupted Plavix after CABG?

After cardiac stents, I know it's one year and I don't take patients off Plavix during the first year due to risk of graft occlusion, and just manage them medically.

Is is the same strict 12 month rule after CABG? I would think that the patient's own vessels used for CABG would be less likely to occlude after 7 days off Plavix, than an artificial stent.

I usually give them 6mo atleast. (no data to support). More improtantly, i ask for 'cardiology' clearnance and advise on this routinely. I put the ball in their court . they typically lovenox bridge these patients is what I've found....

 

[SSdoc33]

they typically lovenox bridge these patients is what I've found....

this is not what i have found.

i am not aware of any standard of care in keeping patients on plavix for greater than a year after a CABG. sometime i see patietns stay of plavix indefiinitely after there has been as "aspirin failure" or patients cannot tolerate aspirin

 

[Jcm800]

this is not what i have found.

i am not aware of any standard of care in keeping patients on plavix for greater than a year after a CABG. sometime i see patietns stay of plavix indefiinitely after there has been as "aspirin failure" or patients cannot tolerate aspirin

I have seen many patients not on ANY blood thinner aside from Asa after cabg...but to be fair these are not fresh Cabg, after many years out

 

[giddyup]

we have 5 cardiac CT surgeons (and 2 more thoracic guys) at my hospital and unless they were on plavix previously for CVA or some other issue they never put them on plavix after CABG. im sure this could vary by institution, though.

also, the length of time they want them off plavix after stents depends on the type of stent. if it is bare metal stent they can go off of plavix after after a month; if it is drug eluting stent, that's when you buy yourself a year.

 

[PMR 4 MSK]

What is the standard of care for non-interrupted Plavix after CABG?

After cardiac stents, I know it's one year and I don't take patients off Plavix during the first year due to risk of graft occlusion, and just manage them medically.

Is is the same strict 12 month rule after CABG? I would think that the patient's own vessels used for CABG would be less likely to occlude after 7 days off Plavix, than an artificial stent.

Leave it up to the prescriber to decide. If it is important enough for them to be on it, taking them off it represents a risk. The prescriber should have beeter understanding of the patient's approximate risks on and off the anticoagulant.

I don't tell people to go off their anticoagulants. I tell them that for me to do the procedure, they need to find out if it is safe for them to go off it for a week. When the prescribing doctor says it's ok, I tell them what day to take their last dose.

 

[Mman]

What is the standard of care for non-interrupted Plavix after CABG?

After cardiac stents, I know it's one year and I don't take patients off Plavix during the first year due to risk of graft occlusion, and just manage them medically.

Is is the same strict 12 month rule after CABG? I would think that the patient's own vessels used for CABG would be less likely to occlude after 7 days off Plavix, than an artificial stent.

If they are on Plavix post CABG, seems to me the Plavix is probably unrelated to the CABG. CABG for stents is to prevent thrombosis in the artificial surface of the stent. CABG patients have their native vessels and are much lower risk for thrombosing in them and I don't know if I've ever seen a patient discharged on anticoagulation after a CABG, except in the case of a-fib.

 

[Gauss]

If they are on Plavix post CABG, seems to me the Plavix is probably unrelated to the CABG. CABG for stents is to prevent thrombosis in the artificial surface of the stent. CABG patients have their native vessels and are much lower risk for thrombosing in them and I don't know if I've ever seen a patient discharged on anticoagulation after a CABG, except in the case of a-fib.

Not true, depends on graft taking. Some will remain indefinitely on anti coagulation if graft fails